Hair or thread tourniquet syndrome is the term used to describe the clinical entity caused by a hair or thread becoming tightly wrapped around an appendage. The proposed mechanism is repetitive movement of the appendage in a confined area (eg, mittens or feet-in pajamas), with resultant wrapping of the offending fiber or hair around the digit. This leads to constriction of the digit, impedance of lymphatic and venous drainage, swelling, edema, and eventual ischemia. With progressive swelling, the constricting agent may become embedded in the soft tissue or cut through the skin. Hair stretches when wet and can be wound loosely around an appendage but will become constrictive as it dries.

EPIDEMIOLOGY

In one review of 66 cases of hair or thread tourniquet syndrome in children, 43 percent involved the toes, 24 percent the fingers, and 33 percent the external genitalia [1].

●Among the children with toe involvement, the median age was four months (range three weeks to 15 months) and hair was the cause of strangulation in 79 percent (picture 1) [1]. This age range has been reported to coincide with maternal telogen effluvium (postpartum hair loss, seen in 90 percent of mothers). Thus, new mothers should be counseled regarding the possibility of hair tourniquets in infants [2].

●Among the children with finger involvement, the median age was three weeks (range four days to 19 months) and fiber or thread was the cause of strangulation in 88 percent. This suggests that finger injuries may be related to the use of mittens to prevent scratching of the face by the fingernails in very young infants.

●Among the children with involvement of the external genitalia, the median age was two years (range four months to six years), most cases involved circumcised boys, and all but one case involved injuries to the penis [1,3]. Rubber bands or other elastic items may also be implicated (picture 2). Rarely, hair tourniquets can involve the clitoris, labia majora, or labia minora in older girls, including adolescents [4-8].

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